Delegated Healthcare Tasks & Your Insurance
In answer to recent queries about this topic, Michael Jobson from TL Dallas has put this very helpful information together, Michael’s contact details are at the end of this document.
Firstly, addressing terminology. The term delegated healthcare tasks is not one that is commonly used by insurers and brokers. Insurers often have the view that there is…
1). Nursing care which is specialised, clinical, and medical care that must be performed by, or under the direct supervision of, a Registered Nurse (RN)
2). Invasive Care = An invasive procedure is any diagnostic or therapeutic intervention that requires physically entering the body. This involves the intentional breach of the body’s natural protective barriers, such as the skin or mucous membranes. Procedures are classified as invasive because they use instruments like needles, scopes, or tubes to access tissue, organs, or body spaces. A good example of this is PEG feeding.
3). Complex Care = A high-dependency, specialised, and often nurse-led form of support required for individuals with significant, ongoing health conditions.
As you can see when care providers are speaking to their broker, they should probably use the term Complex Care as well as Delegated Healthcare Tasks.
Business description is one of the most important parts of your policy because it defines the scope of coverage. If an incident occurs while you are performing an activity not listed in this description, your insurer may potentially deny the claim.
Domiciliary care business descriptions do not normally include invasive / complex / nursing or delegated healthcare tasks in the description so are much more vulnerable to non-disclosure of these material facts.
What is a Material Fact?
A fact is material if it affects the insurer’s assessment of the risk. If an insurer had known a material fact, they might have refused to issue the policy, charged a higher premium, or added special exclusions. Business description falls under this.
What is the Duty of Disclosure For Businesses (Non-Consumers)?
Under the Insurance Act 2015, businesses must provide a “Fair Presentation of Risk”. This requires:
1). Disclosing every material circumstance you know or “ought to know” after a reasonable search of your business.
2). Presenting the information in a way that is “reasonably clear and accessible” (no “data dumping”).
3). Ensuring facts are substantially correct and beliefs are held in good faith.
When in doubt over cover SPEAK TO YOUR BROKER. They will refer this to the insurer who will look to accommodate the additional risk into the existing policy but will need some additional information to do so. In small numbers these cases do not normally result in any increases in premium, it is more of an acceptability question and meeting the non-disclosure and material fact requirements listed above.
What to tell your broker
A). Advise them of any additional delegated tasks you are asked to take on by Local Authorities, General Practitioners or District Nurses. To be thorough I would also advise your broker of any invasive care and certainly any nursing care.
B). Make sure these activities are adequately covered by providing your broker with the following information.
1). If the staff member(s) delivering the has been trained and are competent to deliver the care.
2). The number of service users that are receiving care related to delegated healthcare tasks / invasive care / nursing care.
3). Your total number of all service users
4). The total amount these cases contribute to your annual turnover.
5). Who delegated the task, Local Authorities, GPs, or District Nurses?
C). Ensure that your current policy meets any contractual minimum limits of indemnity (£5mil treatment risk extension or £5mil Professional Indemnity etc.).
While insurers may not ask for sight of wider documentation they will also expect the following is recorded.
A). Training & Competence Records: Evidence that staff have received task-specific training and have been formally assessed as competent by a registered practitioner. Any additional training requirements are recorded and signed by employees which will in turn assist with any claims defensibility.
B). Clinical Oversight: Confirmation of who is responsible for the clinical review and ongoing supervision of the delegated tasks.
C). Updated Documentation: Risk assessments and personalised care plans have been adjusted to reflect these high-risk activities.
Associated Costs
It is quite rare, that insurers charge higher premiums for Delegated Healthcare Tasks. Insurers will either accept the perceived additional risk on the policy or they will decline.
Different insurers have different appetites, with the lower end of the market insurers being quite risk adverse to DHT’s. I have only seen two instances when acceptance of DHT’s came with increased premiums. If care providers are planning on taking on DHT’s then they should speak to their care specialist broker first. There are many occasions when the additional risk is not acceptable and we have to move clients to a new insurer mid-term through a policy.
I hope that helps. I’ve tried to be as practical as I can while giving some insight into service providers duties and insurers requirements. I have not touched on regulatory requirements as the insurer will normally assume that the client has the correct CQC registration to provide this care and may not always check. If you would like any further discussion or clarification, please let me know.
Michael Jobson, Cert CII
Corporate Account Executive
07534 360404
T L Dallas (City),
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Direct Dial: – | Mobile: 07534 360404 | Email: michael.jobson@tldallas.com | Website: www.tldallas.com